Let me be the first one to say that my goal- in life, as a therapist, as the child or the grandchild, is to always be able to help people get home after illness or injury or to age successfully in their home.

So what happens when home isn't the safest place for you or your loved one to be? How do you know? Who can you ask? What are the next steps?

The answers to these questions are simple and complicated.

When home is no longer an option it depends on where you are when the decision is made. If you are in the hospital or rehab, you'll continue along in the system, progressively to a less acute facility, until an assisted living or skilled nursing facility bed opens up. Usually the continuum is: hospital- acute/subacute rehab- skilled nursing (potentially while you wait for a room to open)- finally to assisted living or skilled depending on the level of assistance required.

If you are at home, the next steps would be to contact a home care company if you currently do not have services coming to the home, either privately funded or through your insurance. People will usually try to increase services to see if that helps push off the decision. You can also refer yourself to a facility. It's not common practice to self-refer, in my experience it is usually done by the care giver once they've seen a marked decline or if they have tried to discharge home unsuccessfully from a hospitalization. It is not the easiest route and you run the risk of the facility being full and being left with minimal options.

Figuring out the "right time" to make this choice is the hardest part. Hospitalizations provide concrete data to support a decision either way. They also provide the opportunity to connect with Occupational, Physical, and Speech Therapists to weigh in with their expertise. So what happens if your parent is in the hospital and you know that home is not an option, regardless of the modifications or level of assistance that can be provided? And all these health professionals are affirming your decision- but your parent is steadfast in their decision to go home.

Have a home assessment

In my experience, no amount of professional jargon, data, or opinion is going to come through for someone wanting to go home, until they have a chance to try on their own.

These assessments are opportunities to allow individuals to try for themselves, to help them make their own decision about being safe at home. These are vulnerable moments, being confronted with the reality that the safety of home is not what it used to be. But they are incredibly valuable to that individual. Instead of being told, they are able to make the decision on their own. It eliminates the "what if" and releases the burden of that guilt on families. And in the end, will hopefully ease the transition to a safer environment.

I could write endlessly about prevention and the importance of planning for the future when it comes to aging and health. Maybe it means downsizing to a smaller and more manageable home. A first floor bedroom and full bathroom. One with an option to install on overhead lift. Maybe it means knowing the end point before starting to look for an assisted living facility.

Whatever lengths you are comfortable with, these decisions are yours.

The earlier and more explicit these choices are made, the greater chance for success in implementation.